Ashley Battista MOT, OTR/L, and Anne Overcash, MEd, give practical tips on how to modify PECS pictures.

Your team has decided to teach PECS to a learner. Everyone agrees this is a perfect fit. Reinforcement assessment – complete! Pictures made and protected! Someone on the team, maybe you, voices a concern. How will the learner pick up and hold on to the picture (and later, the Sentence Strip) and exchange it with a communication partner? This learner has difficulty handling small items and a variety of learning materials.

Often, an Occupational Therapist (OT) is already part of the support team. This person will be a most valuable resource for recommendations and guiding the team through the development and modification of adapted PECS pictures. Picking up a picture, holding on to it, and then releasing it into someone’s hand requires fine motor, gross motor, and manipulation skills. There may already be a grasp and release profile developed for this person, if so, starting with this information will be most helpful in the creation of accessible pictures.

During the assessment of preferences, observe and consider carefully how this person interacts with the things they love the most. Are they able to manipulate some things with ease? Are there certain characteristics that those things have in common? Do they more frequently grasp with one finger to thumb, two fingers to thumb, or all four fingers to their palm? The OT will assess a range of skills within many functional activities including activities of daily living. General observations along with feedback provided by the OT will assist the team in providing optimal modifications and suggesting additional modifications if one does not work.

Motivation is everything! Consider probing Phase I skills with standard pictures. They may have no difficulty at all, even if our assessments suggest otherwise.

Phase I, no need to attach the picture (or adapted picture) with Velcro to the communication book/board. However, we do recommend adding Velcro to the back of each picture/symbol. This creates a bit of lift/separation between the surface and the picture and allows for ease in picking it up. Traditionally laminated pictures may be a bit too flimsy. Here are some ways to create a sturdier picture:

  • Print the pictures on sturdier paper (ex: cardstock) before laminating
  • Tape or glue the laminated picture to a square of cardboard
  • Decoupage the picture onto a square of wood (lightweight like balsa wood works well)
  • Glue the laminated picture inside a metal lid
  • Attach the picture to a square bit of sponge
  • Tape or glue the laminated picture to a blank stamp

Note: When assessing a specific modification, consider attaching pictures to the modified medium via Velcro initially. If a modification works well, then make an adapted symbol for each individual picture.

Pictured are images glued to various types of objects like blocks and sponges.

Pictures are glued to metal lids for mason jars or other glass containers.

Modified pictures ready to go? Teach Phase I with these.

Successful? Great! No need to eliminate the modification. All future symbols will be made the same way. However, the team may choose to begin to reduce or eliminate the modification for ease of access and/or to accommodate more pictures within a PECS communication book.

Two ways to reduce or eliminate modifications:

1. Probe skills with standard pictures

2. Reduce/eliminate modification

Probe skills: Periodically provide the standard laminated picture instead of the modified picture within a highly motivating activity. Document performance. If they are just as independent with the standard picture, proceed with these as you continue to teach the six phases of PECS. If not, continue to use the modified pictures.

Reduce/eliminate modification: How a tall stack became a short stack – a real world example. In classroom, a picture was glued atop 9 stacked and glued squares of craft foam. Input from the OT guided the team as they taught Phase I of PECS using stacks of varying heights. The team arrived at this number because this stack was the shortest stack required for success with Phase I. After a couple of days of independently exchanging these adapted symbols, the team removed 1 square from the stack and the PECS user remained successful! This method allowed for a stack tall enough for them to be successful yet a shorter and shorter stack over time. Ultimately, the stack was 2 squares tall. This material is virtually weightless. Each adapted picture weighed about the same as a traditionally laminated picture. These adapted pictures fit neatly inside a PECS book ready for easy transport.

Sometimes pictures are adapted only after beginning to teach PECS and we observe the learner is having difficulty picking up, holding onto, and/or letting go of the picture. Other times, teams adapt symbols prior to beginning. Either way, teams work diligently to increase independence and access for all PECS users.

What modifications to pictures have you made for your PECS users?


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Written By Ashley Battista MOT, OTR/L and Anne Overcash, MEd

© Pyramid Educational Consultants, LLC. 2023